Zensa Hospital

Diaphragmatic eventration (DE) is characterized by abnormal diaphragm elevation resulting from muscle weakness or thinning. It may be congenital or acquired, affecting both pediatric and adult populations, and is associated with symptoms such as dyspnea and chest pain. Although DE is infrequent, with a higher incidence on the left side, it has traditionally been managed through invasive surgical techniques. Advances in endoscopic methods, including thoracoscopic and laparoscopic plication, have revolutionized treatment by offering reduced postoperative pain, faster recovery, and improved precision. Despite these benefits, potential complications such as pneumothorax and diaphragm rupture remain concerns. We report two cases of ruptured DE and their management. Effective management requires meticulous surgical technique and consideration of individual patient factors to optimize outcomes and minimize complications.

The use of oxytocics immediately after the delivery of the baby is one of the most important intervention, to prevent postpartum blood loss, as uterine atony is the most important and common cause of postpartum haemorrhage. This study aims to evaluate whether intra-umbilical oxytocin in the AMTSL can reduce the duration and amount of bleeding as compared to intravenous methergine. The mean estimated blood loss in women treated with intraumbilical oxytocin was 213.50 whereas in intravenous methergine was 215ml; P

Hydatid disease commonly affects liver and treatment of choice is surgery. Ultrasound examination is helpful to diagnose, classify and plan management of the cyst. Surgical treatment is done using a conventional open technique or minimal access technique. We report our experience of using ultrasound-guided percutaneous nephroscopic approach to treat liver hydatid cyst.

NPHP1, the gene that encodes the protein nephrocystin-1 has been identified to be mutated in Juvenile Nephronophthisis, an autosomal recessive cystic kidney disorder which is the most frequent genetic cause of end-stage renal disease (ESRD) in children and young adults. Nphp1-targeted mutant mice studies have shown that it did not express renal manifestations of nephronophthisis; instead male mice were infertile with oligoteratozoospermia signifying the crucial role of Nphp1 in relation to murine spermatogenesis. Whether an aberrant expression of NPHP1 in testis might lead to spermatogenic defects in human and ultimately male factor infertility is a possibility that have not been investigated so far. In this regard, characterization of NPHP1 in spermatozoa from fertile and infertile males was carried out by employing RT-PCR, western blotting, and immunofluorescence analysis. In all the 23 normozoospermic samples we screened, NPHP1 was significantly expressed at the target message and protein level and also prominent localization pattern of NPHP1 was observed at the head, midpiece, and tail segments of spermatozoa. Conversely, in majority of the 103 infertile samples we screened, aberrant pattern of NPHP1 expression was detected at the transcript and protein level and abnormal localization pattern of expression was observed in spermatozoa. Anomalies detected in infertile cases when compared with the normozoospermic controls points to the indispensable role of NPHP1 in relation to spermatogenesis. Thus, besides the decisive association with juvenile nephronophthisis, our study provides the first direct evidence that NPHP1 is associated with male factor infertility and also could be a possible biomarker for the assessment of male fertility status. GENBANK NM_000272.3

Mixed stones form a significant number of all urinary stones. Accurate analysis of individual areas of stones is fraught with uncertainties. Scanning electron microscopy with elemental distribution analysis (SEM-EDAX) is a very important tool in assessing stone composition. The objective of this paper is to project the role of the combination of Fourier transform infrared (FTIR) spectroscopy and SEM-EDAX combination in achieving a total understanding of mixed stone morphology. Ten mixed urinary stones were washed and dried and the composition recognized by analysis of FTIR spectra by comparing with the spectra of pure components. Spectra for different layers were obtained. Then the stone samples were further studied by SEM-EDAX analysis. The findings of FTIR were correlated with SEM-EDAX and detailed data generated. Using SEM-EDAX, the spatial distribution of major and trace elements were studied to understand their initiation and formation. As much as 80% of the stones studied were mixtures of calcium oxalate monohydrate (whewellite) and calcium phosphate (hydroxyapatite) in various proportions. Quantitative evaluation of components was achieved through FTIR and SEM-EDAX analysis. It was possible to get an idea about the spatial distribution of molecules using SEM analysis. The composition of different areas was identified using EDAX. Analyzing with EDAX, it was possible to obtain the percentage of different elements present in a single sample. The study concludes that the most common mixed stone encountered in the study is a mixture of calcium oxalate monohydrate and calcium phosphate in a definite proportion. The combination identified not only the molecular species present in the calculus, but also the crystalline forms within chemical constituents. Using EDAX, the amount of calcium, phosphorus, oxygen and carbon present in the stone sample could be well understood.

We determined whether triple therapy comprising amantadine (AMA), ribavirin (RBV) and either peginterferon (PEG-IFN) alpha-2a or conventional IFN alpha-2a would improve sustained virological response (SVR) rates over dual therapy with IFN alpha-2a and RBV in patients with chronic HCV infection. A total of 362 treatment-naïve patients were randomized to 48 weeks of treatment with: PEG-IFN alpha-2a 180 microg/week (group A) or IFN alpha-2a 3 MU tiw (groups B and C). All patients received RBV 1000 or 1200 mg/day and those in groups A and B received AMA 200 mg/day. SVR was defined as an undetectable HCV RNA after 24 weeks of untreated follow-up. At the end of therapy, 74.4% (95% CI 0.66-0.82) of patients in group A were HCV RNA-negative compared with 42.5% (95% CI 0.33-0.50) of those in group B (P = 0.0001) and 48.8% (95% CI 0.40-0.56) of those in group C. SVR was achieved in a significantly greater proportion of patients in group A compared with groups B and C: 65.3% (95% CI 0.53-0.56), 33.3% (95% CI 0.25-0.41) and 44.6% (95% CI 0.36-0.53; P = 0.0001) respectively. In patients with genotype 1, SVR rates were 55.2, 22.8 and 28.8% with the three regimens respectively. Factors independently associated with SVR were HCV genotype 2 or 3, therapy with PEG-IFN, female gender and age. In treatment-naive patients with chronic hepatitis C, triple therapy with PEG-IFN alpha-2a, RBV and AMA produces higher SVR than dual or triple therapy with conventional IFN alpha-2a.